Genetic background

The genetic predisposition of a patient can also significantly influence the success of an implantation. Especially in combination with other risk factors, certain gene variations significantly increase the risk of peri-implant disease.

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Analogous to periodontitis, the immune system also plays an important role in the development of peri-implantitis. The keyplayers in this context are the cytokines interleukin-1A (IL-1A) and interleukin-1B (IL-1B) and their counterparts, the interleukin-1 receptor antagonist (IL-1RN). IL-1 is an important inflammatory mediator in the control of bacterial pathogens or defective cells. IL-1 also occupies a key position in bone metabolism: By activating the osteoclasts and inactivating the osteoblasts, it shifts the balance towards bone resorption.

When the immune system overreacts

Patients who carry specific variations in the IL-1 genes respond to inflammatory stimuli with an overproduction of this messenger. They therefore show a significantly increased bone loss as well as a generally increased hereditary inflammatory tendency. In particular, in patients having additional risk factors (e.g. smoking) a positive IL-1 genotype is associated with significantly higher disease and complication rates. For example, 50 % of smokers with this particular genetic predisposition must expect implant failure or significant biological complications such as higher attachment loss.

Analysis of the IL-1 polymorphism

Especially with smokers, an analysis of the IL-1 polymorphism prior to implantation is urgently recommended, since these patients have to reckon to 50 % with implant failure or significant biological complications such as higher attachment loss if they carry the respective gene modifications. According to studies by Laine et al., also a variation in the IL-1RN-encoding gene is associated with an increased susceptibility to peri-implantitis and therefore represents a risk factor. Thus, an analysis of the IL-1 polymorphism (e.g. GenoType IL-1) may be a valuable aid in determining the therapeutic regimen.

Close monitoring of risk patients

Patients with variations in the IL-1 genes should be monitored very closely and should reduce additional periodontal risk factors. Patients who are more prone to inflammation may require adjunctive antibiotic therapy already at an earlier stage of treatment. The knowledge of the IL-1 risk type allows the treating dentist not only to estimate the course of the disease, but also to establish individually adapted recall intervals.